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Individual

MR. RICHARD KENNETH PETERSON

Active
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Individual

MR. RICHARD KENNETH PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0067446
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080119192
MEDICARE RAILROAD
FL
01
—
148899
HEALTHEASE
FL
01
—
26755
BCBS
FL
05
—
379680900
—
FL
01
—
4653879
AETNA
FL
01
—
5562171-001
CIGNA
FL
Enumeration date
08/22/2005
Last updated
11/11/2009
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